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By  Austin  Flii/t 


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UNIVERSITY  OF  CALIFORNIA,  SAN  DIEGO 
LA  JOLLA,  CALIFORNIA 


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W  9  F623m  1886 
UNIVERSITY  OF  CALIFORNIA,  SAN   DIEGO  B 


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MEDICINE  OF  THE  FUTURE 


AN  ADDRESS  PREPARED  FOR  THE  ANNUAL 

MEETING  OF  THE  BRITISH  MEDICAL 

ASSOCIA  TION  IN  1886 


BY 

AUSTIN    FLINT    (Senior),    M.  D.,  LL.  D. 


NEW  YORK 
D.     APPLETON     AND     COMPANY 

I,   3,   AND   5    BOND   STREET 
1886 


Copyright,  1886, 
By  D.  APPLETON  AND  COMPANY. 


The  late  Dr.  A  ustin  Flint  tvas  appointed  to  read 

the  address  on   Medicine   before  the  British   Medical 

Association  at  its  meeting  in  1886.       The  manuscript 

was   found    among  his   papers   and    the    address    is 

printed  precisely  as  it  zvas  written.      The  proof  was 

reverently   read   by  his   son,    zvho   dedicates   this,   his 

fathers   last   literary   work,    to   the  profession   he  so 

loved  and  adorned. 

AUSTIN  FLINT. 

April  24,  1SS6. 


MEDICINE  OF  THE  FUTURE. 


The  meditations  of  a  medical  practitioner  whose 
retrospections  extend  over  half  a  century  may  natu- 
rally be  expected  to  revert  to  the  past.  To  re- 
view the  progress  of  medicine  for  fifty  years,  to 
make  comparisons  of  the  beginning  and  the  end  of 
that  period,  to  revive  the  enthusiasm  of  by-gone 
days — these  are  among  the  resources  of  those  who 
may  be  called  medical  semi-centenarians.  In  the 
ability  to  look  backward  through  so  long  a  period, 
is  to  be  found  some  compensation  for  deprivations 
incident  to  the  passage  of  one's  life  beyond  youth 
and  middle  age.  Retrospection  has  uses  apart 
from  this  compensatory  gratification  ;  but,  if  too 
absorbing,  it  impairs  appreciation  of  the  present 
and  faith  in  the  future.  To  look  forward,  as  well 
as  backward,  is  both  interesting  and  useful.  If  our 
retrospections  extend  over  half  a  century,  it  is 
worth  while  to  inquire,  How  will  the  present  ap- 
pear in  a  retrospective  view  at  the  end  of  the  next 


6  MEDICINE  OF   THE  FUTURE. 

fifty  years  ?  In  the  spirit  of  this  inquiry,  I  shall  sub- 
mit some  thoughts  on  medicine  of  the  future. 

I  assume  that  medicine,  as  it  is  to-day,  will 
not  remain  stationary.  In  everything  relating  to 
human  knowledge,  anticipations  have  no  basis 
other  than  experience.  The  past  history  of  medi- 
cine shows  a  law  of  progress  ;  hence,  medicine  will 
continue  to  advance.  I  shall  view  this  conclusion, 
however,  from  another  and  a  higher  standpoint.  If 
we  believe  in  an  overruling  Creator  and  Governor 
of  the  universe,  everything,  however  great  or  how- 
ever small,  must  be  in  accordance  with  a  divinely 
ordered  plan.  Diseases  doubtless  have  their  uses, 
some  of  which  are  apparent  to  human  comprehen- 
sion. The  prevention  and  the  successful  manage- 
ment of  diseases  also  enter  into  providential  design. 
The  past  gives  an  assurance  of  progressively  in- 
creasing security  of  human  life  from  diseases.  The 
progress  of  medicine  belongs,  therefore,  in  the 
order  of  Providence. 

Past  experience  shows  that  medicine  advances 
by  means  of  discoveries  and  improvements  which 
mark  epochs  in  its  history.  Immediately  preced- 
ing the  beginning  of  the  last  half-century,  follow- 
ing the  discovery  of  vaccination,  by  Jenner,  and  the 
developments  in  anatomy,  physiology,  and  pathol- 
ogy, by  the  researches  of  John  Hunter,  were  the 


MEDICINE  OF   THE  FUTURE.  7 

discovery  of  auscultation  by  Laennec,  the  inaugura- 
tion of  renal  pathology  by  Richard  Bright,  the  crea- 
tion of  general  anatomy  by  Bichat,  and  the  advance- 
ment in  knowledge  of  the  nervous  system  by  the 
experiments  of  Magendie  and  Charles  Bell.  These 
were  epochs  occurring  in  quick  succession.  The 
epochs  within  the  last  half-century  have  been  as 
many,  as  important,  and  as  rapid  as  during  the  pre- 
vious fifty  years.  They  whose  retrospections  em- 
brace this  period  of  time  can  recall  the  discovery 
of  the  reflex  system  of  nerves,  and  of  the  separate 
functions  of  different  portions  of  the  spinal  cord ; 
the  study  of  diseases  after  the  numerical  method ; 
the  recognition  of  the  self-limitation  of  certain  dis- 
eases and  knowledge  of  their  natural  history ;  the 
creation  of  histology,  by  means  of  the  microscope  ; 
the  localization  of  certain  of  the  cerebral  functions  ; 
the  employment  of  anaesthetics  and  their  applica- 
tions in  medicine  as  well  as  in  surgery  and  ob- 
stetrics; the  clinical  introduction  of  the  ophthal- 
moscope and  the  laryngoscope ;  the  clinical  use 
of  the  thermometer;  and,  as  a  crowning  epoch, 
the  more  recent  revelations  respecting  the  bacterial 
origin  of  diseases.  Now,  suppose  that  whoever  may 
be  honored  by  an  invitation  to  read  an  address 
on  medicine  at  the  annual  meeting  of  the  British 
Medical  Association  in  the  year  1936  should  select 


8  MEDICINE  OF   THE  FUTURE. 

as  his  theme  the  history  of  medicine  for  the  pre- 
ceding half-century,  is  it  to  be  doubted  that  the 
epochs  belonging  to  this  history  will  be  found  to 
be  not  less  in  number  and  in  importance  than  those 
which  signalized  medical  progress  during  the  first 
half  of  the  century  ending  at  that  date  ?  Does  not 
the  history  of  medicine  show  a  steady  acceleration 
in  progress,  so  that,  judging  by  the  past,  these  next 
fifty  years  will  be  richer  in  epochs  than  the  pre- 
vious half-century  ?  * 

Has  our  knowledge  of  the  organs,  tissues,  and 
chemical  constituents  of  the  body  reached  its  limi- 
tations? About  half  a  century  ago,  Horner,  of 
Philadelphia,  described  a  lachrymal  muscle,  which 
bears  his  name,  measuring  three  lines  in  breadth 
and  six  lines  in  length.  At  that  time  this  little 
muscle  seemed  the  only  thing  left  for  discovery 
in  macroscopical  anatomy.  But  soon  afterward,  a 
new  continent  in  this  department  of  medicine  was 
discovered,  and  the  question  now  is,  How  much 
further    can    future    exploration    in    microscopical 


*  Sir  James  Paget,  in  his  inaugural  address  at  the  opening  of  the 
International  Medical  Congress  in  1881,  expressed  his  belief  that  the 
progress  of  science  "  in  the  last  fifty  years  was  twice  as  great  as  that 
in  the  previous  fifty,"  and  that  "  the  rate  of  progress  should  constantly 
increase."  If  the  latter  belief  be  in  accordance  with  the  order  of 
Providence,  how  interesting  will  be  the  retrospections  of  half  a  century 
in  1936  ! 


MEDICINE  OF   THE  FUTURE.  g 

anatomy  be  extended  ?  To  particularize  the  epochs 
to  take  place  in  the  future  would  be  equivalent  to 
making  them ;  but  conjecture  respecting  the  means 
by  which  they  are  to  be  made  is  admissible.  It  is 
probable  that  the  construction  of  the  microscope 
admits  of  continued  improvements.  The  illumina- 
tion of  microscopical  objects  may  be  increased. 
The  practical  applications  of  the  spectroscope  may 
be  enlarged.  The  developments  in  optics  may 
furnish  new  methods  of  observation.  The  process 
of  staining,  which  has  recently  done  so  much  for 
pathology,  may  be  extended  and  applied  to  the 
study  of  the  normal  as  well  as  morbid  compo- 
nents of  the  body.  It  is  a  fact,  significant  as  re- 
gards the  future,  that  the  use  of  dyes  has  brought 
into  the  range  of  vision  objects  which,  without 
their  use,  the  microscope  fails  to  make  visible. 

Analytical  chemistry  carries  investigation  be- 
yond the  limits  of  microscopical  observation.  The 
latter,  at  the  present  moment,  both  in  pathology 
and  physiology,  seems  to  promise  most ;  but  is  it 
not  a  rational  anticipation  to  look  for  future  results 
from  chemical  analysis  of  the  components  of  the 
body,  in  health  and  disease,  which  in  brilliancy  and 
practical  utility  may  surpass  those  of  the  labors 
in  this  field  of  investigation  during  the  past  half- 
century  ?    The  medical  semi-centenarian  can  recall 


IO  MEDICINE  OF   THE  FUTURE. 

the  enthusiasm   aroused  by  the   labors  of   Liebig. 
Histology  is  now  in  the  ascendant,  but  it  is   safe 
to  predict  that,  before  the  lapse  of  another  half- 
century,   there    will    be    another    era    in    organic 
chemistry,  and  that   light  will  penetrate   dark  re- 
cesses which  histology  can  not  reach.     Tracing  to 
protoplasmic  cells  physiological  and  pathological 
processes  brings  us  in  close  proximity  to  these  pro- 
cesses, but  they  are  not  thereby  elucidated.     His- 
tology may  disclose  the  agents,  but  it  leaves  us  in 
the  dark  as  regards  the  agencies.     How  is  it  that 
secretions,  excretions,  nutrition,   growth,  and  cer- 
tain  morbid    products  are  brought  about?      This 
question  can  not   be   answered  with  our   existing 
knowledge,  and  the   answer  must  come   from    or- 
ganic chemistry.     The  supreme  objects  of  study  in 
pathology  at  the  present  time  are  the  discovery  of 
micro-organisms   and   their    natural   history.     But 
these  agents,  it  is  probable,  are  pathogenetic,  not 
directly,  but  indirectly,  by   means   of   the   toxical 
products  of  their  activity.     What  are  these  prod- 
ucts, and  how  do  they  give  rise  to  the  phenomena 
of  disease  ?     We  may  ask  the  same  question  of  cer- 
tain of  the  poisons   introduced   from  without   the 
body.     How  is  it  that  fractional  quantities  of  mor- 
phia, hyoscyamin,  strychnia,  aconitia,  atropia,  and 
other  alkaloids,   produce   their   lethal   effects?     It 


MEDICINE  OF   THE  FUTURE.  \  \ 

conveys  no  adequate  information  to  say  that  they 
act  upon  the  nervous  system.  This  is  merely  the 
statement  of  a  fact,  not  an  explanation.  For  the 
latter,  we  must  look  to  the  organic  chemistry  of 
the  future. 

The  progress  of  medicine,  so  far  as  it  depends 
on  observation,  has  been  effected  especially  by  the 
sense  of  sight.  The  sense  of  hearing,  it  is  true,  has 
contributed  most  important  information,  especially 
respecting  the  organs  within  the  chest.  It  is  need- 
less to  refer  to  the  knowledge  obtained  bv  means 
of  auscultation  and  percussion  of  the  lungs  and 
heart.  A  large  share  of  this  knowledge  has  been 
obtained  within  the  last  half-century.  It  is  need- 
less, also,  to  refer  to  the  marvelous  developments, 
within  the  last  few  years,  of  knowledge  respecting 
the  transmission  of  sounds  outside  of  the  body,  as 
exemplified  by  the  telegraph,  the  telephone,  the 
microphone,  and  the  phonograph.  These  develop- 
ments have  not  as  yet  added  much  to  our  knowl- 
edge of  the  normal  and  abnormal  actions  taking 
place  within  the  body.  Much  is  to  be  expected 
from  this  source  in  the  future.  It  seems  to  me  cer- 
tain that  the  principle  of  the  telephone  will,  by-and- 
by,  be  applied  to  intra-thoracic  respiratory  and 
heart-sounds,  so  that  they  will  be  transmitted  to 
the    ear   with    more    distinctness   than    they   now 


12  MEDICINE  OF   THE  FUTURE. 

are  by  the  binaural  stethoscope.  The  healthy  and 
morbid  sounds  will  then  be  so  easily  observed  as 
to  render  the  physical  diagnosis  of  pulmonary  af- 
fections in  all  cases  a  very  simple  problem.  More 
than  this,  the  clinical  teacher  may  be  able  to  dem- 
onstrate auscultatory  signs  to  a  class  of  medical 
students  comfortably  seated  in  the  lecture-room  or 
hospital  amphitheatre.  The  same  is  to  be  said  of 
auscultation  of  the  heart.  The  cardiac  murmurs 
and  the  sound  produced  by  each  of  the  valves  of 
the  heart  separately,  will  be  observed  more  readily 
and  satisfactorily  than  with  our  present  means  of 
observation.  I  will  go  further,  and  say  that  intra- 
thoracic sounds  may  be  transmitted  from  the  pa- 
tient to  the  physician,  no  matter  how  distant  may 
be  the  one  from  the  other.  Again,  and  still  fur- 
ther, the  sounds  from  the  chest  of  a  patient  may 
be  phonographically  registered,  transported  never 
so  far,  and  made  available  after  an  indefinite  period. 
All  these  results  would  not  be  more  wonderful 
than  the  invention  of  the  telegraph,  the  telephone, 
the  microphone,  and  the  phonograph,  all  of  which 
have  been  devised  within  the  last  half-century. 

I  may  mention  an  incident,  an  account  of  which 
I  recently  read  in  a  newspaper,  illustrative  of  a 
practical  use  of  the  telephone  in  diagnosis.  A  tele- 
phonic communication  existed  between  the  house 


MEDICINE  OF   THE  FUTURE.  13 

of  a  physician  and  the  distant  residence  of  a  pa- 
tient. The  physician  was  summoned  to  visit  a 
child  'in  the  house  of  the  patient  in  the  night-time. 
The  physician  naturally  asked,  "  What  is  the  mat- 
ter ? "  The  answer  was  that  a  child  had  croup. 
Said  the  physician,  "  Bring  the  child  close  to  the 
telephone  that  I  may  listen  to  the  cough."  This 
was  done.  The  cough  was  heard,  and  the  physi- 
cian telephoned  his  opinion  and  instructions,  with- 
out the  necessity  of  making  a  night-visit.  A  de- 
scription of  the  symptoms  in  certain  cases,  transmit- 
ted by  means  of  the  telephone,  may  not  infrequently 
spare  both  the  physician  and  the  patient  the  incon- 
venience of  a  journey  either  in  the  night  or  day 
time.  How  far  it  may  be  for  the  interest  of  the 
physician  to  make  use  of  the  telephone  in  this  way, 
depends  on  circumstances,  the  consideration  of 
which  is  not  especially  suited  to  this  occasion. 

In  1705,  Robert  Hook,  who,  as  we  are  told, 
"  was  for  many  years  a  prime  mover  in  English 
science — mathematician,  physicist,  chemist,  engi- 
neer, microscopist,  physiologist,  virtuoso,  and  city 
surveyor — a  man  of  almost  unbounded  fertility  and 
vast  energy,"  uttered  this  prophetic  exclamation : 
"  Who  knows  but  that  one  may  discover  the  works 
performed  in  the  several  offices  and  shops  of  a  man's 
body  by  the  sounds  they  make,  and  thereby  dis- 


H 


MEDICINE  OF   THE  FUTURE. 


cover  what  instrument  or  engine  is  out  of  order  !  "  * 
Were  Hook  now  living-,  he  might  claim  that  his 
prophecy  has  been  fulfilled  by  the  developments 
in  auscultation  of  the  respiratory  organs  and  the 
heart.  Moreover,  auscultation  has  developed  signs 
in  addition  to  those  relating  to  the  voice,  the  respi- 
ration, and  cardiac  sounds.  Fifty  years  ago,  Fisher, 
of  Boston,  found,  on  applying  the  stethoscope  over 
the  fontanelles  in  infants,  a  bellows-murmur  in  cases 
of  cerebral  diseases.  Another  of  my  countrymen, 
Hooker,  of  New  Haven,  studied  the  intestinal  bor- 
borygmi  in  cases  of  colic.  Murmurs  in  the  arteries 
and  veins,  and  in  the  several  varieties  of  aneu- 
risms, as  is  well  known,  afford  important  informa- 
tion. Pregnancy  and  the  prospect  of  twins  may  be 
ascertained  by  listening  to  the  sounds  of  the  foetal 
heart.  A  collection  of  gall-stones  is  sometimes 
made  known  by  the  noise  they  make,  and  hydatids 
have  been  recognized  by  a  musical  tone.  But  the 
fulfillment  of  Hook's  prophecy  is  not  yet  complete. 
At  the  present  day,  we  may  say,  Who  knows  but 
that,  with  improvements  in  instruments  for  the  con- 
duction and  intensification  of  sounds,  one  may  study 
normal  and  abnormal  conditions  of  the  circulation  in 
all  the  internal  organs  of  the  body,  "  by  the  sounds 

*  "  Inaugural  Address,"  by  Dr.  Michael  Foster,   President  of  the 
Section  on  Physiology,  at  the  International  Medical  Congress  of  1881. 


MEDICINE  OF   THE  FUTURE.  15 

they  make  "  in  the  processes  of  secretion  and  excre- 
tion, of  nutrition  and  of  morbid  growths  ?  It  can 
hardly  seem  an  extravagance  to  predict,  then,  of  the 
future  developments  of  auscultation  to  one  who  has 
listened,  with  the  aid  of  the  microphone,  to  the  foot- 
steps of  a  fly. 

A  half-century  ago,  the  profession  had  acquired 
but  imperfect  knowledge  of  the  natural  history  of 
diseases — that  is,  the  history  of  diseases  pursuing 
their  course  unaffected  by  active  measures  of  treat- 
ment. The  importance  of  this  knowledge  was  not 
fully  appreciated.  Diseases  which  we  now  know 
to  be  self-limited  in  duration,  and  to  tend  intrinsical- 
ly to  recovery,  were  treated  as  if  their  continuance 
were  indefinite  and  their  course  interminable,  irre- 
spective of  active  therapeutic  measures.  The  in- 
fluence on  therapeutics  of  the  knowledge  of  the 
natural  history  of  diseases,  acquired  within  the  last 
fifty  years,  has  been  great.  It  is  evident  that  this 
knowledge  is  the  true  point  of  departure  for  esti- 
mating the  effect  of  treatment,  and  that  without 
this  knowledge  the  conclusions  derived  from  clini- 
cal experience  must  often  be  erroneous.  There  is 
still  room  for  the  increase  of  this  knowledge,  and 
in  this  direction  we  are  to  look  for  further  influ- 
ence on  therapeutics.  With  the  now  prevailing 
views,  it  seems  a  surprising  statement  that  phthisis 


1 6  MEDICINE  OF   THE  FUTURE. 

pulmonalis  may  be  self-limited  and  end  in  recovery 
purely  from  an  intrinsic  tendency ;  yet,  I  venture 
the  assertion  that  the  correctness  of  the  statement 
has  been  substantiated,  and  that  before  many  years 
elapse  it  will  be  generally  acknowledged  to  be  a 
clinical  fact.  How  important  is  this  fact  in  judging 
of  the  agency  of  medicinal,  climatic,  and  hygienic 
measures  in  the  treatment  of  this  disease ! 

Assuming,  as  we  must,  that  the  only  solid  basis 
of  therapeutics  is  clinical  experience,  and  appre- 
ciating the  many  and  almost  insuperable  difficulties 
in  the  way  of  educing  therefrom  conclusions  which 
approximate  to  the  "  inflexibility  of  arithmetic,"  it 
is  an  interesting  inquiry,  What  will  be  the  status  of 
the  therapeutical  principles  which  have  heretofore 
governed  and  of  those  which  now  govern  the  prac- 
tice of  medicine?  The  medical  semi-centenarian 
has  lived  through  radical  changes  in  medical  prac- 
tice, especially  as  regards  inflammatory  affections. 
The  so-called  antiphlogistic  measures  —  blood-let- 
ting, general  and  local,  mercurialization,  active 
counter-irritation,  emetics  and  cathartics,  conjoined 
with  starvation  diet,  which,  fifty  years  ago,  were 
considered  as  indicated  whenever  and  wherever 
inflammation  was  supposed  to  exist — have  of  late 
years  been  practically  repudiated.  Formerly  the 
physician  who  failed  to  employ  them  would  have 


MEDICINE  OF   THE  FUTURE. 


17 


been  considered  culpable.  The  physician  who 
should  now  resort  to  antiphlogistic  measures,  as 
they  were  formerly  employed,  could  not  expect  to 
escape  with  simply  the  charge  of  fogyism ;  his 
practice  would  be  open  to  censure.  Now,  was  the 
practice  in  former  days  altogether  wrong,  and  is 
the  practice  of  the  present  time  altogether  right  ? 
I  shall  apply  this  question  to  the  most  potential 
antiphlogistic  measure,  namely,  blood-letting,  with 
the  understanding  that  my  remarks  are,  to  a  great- 
er or  less  extent,  applicable  to  the  other  so-called 
antiphlogistic  measures. 

On  an  occasion  which  had  called  together  a 
considerable  number  of  medical  practitioners,  the 
question  being  raised  how  many  lancets  could  be 
at  the  instant  exhibited,  it  so  happened  that  not  one 
of  those  present  had  a  lancet  in  his  pocket.  None 
had  recognized  the  liability  to  an  emergency  which 
might  call  for  prompt  venesection.  This  occur- 
rence was  on  the  other  side  of  the  Atlantic ;  but  it 
would  certainly  not  be  fair  to  infer  that  the  same 
thing  could  happen  at  an  assemblage  of  British 
practitioners.  However  that  may  be,  there  is  not 
much  risk  in  hazarding  a  prediction  that,  long  be- 
fore the  expiration  of  the  next  half-century,  no  prac- 
titioner of   medicine    will   be   without  a  lancet  at 

hand  for  immediate  use.     There  will  then  be  no 
3 


1 8  MEDICINE  OF   THE  FUTURE. 

longer  pertinency  in  the  title  of  a  paper  written  but 
a  few  years  since  by  my  lamented  friend,  the  late 
Professor  Gross,  in  reference  to  venesection,  name- 
ly, "  A  Lost  Art  in  Surgery." 

I  shall  not  undertake  to  sustain  this  prediction 
by  a  comparison  of  past  with  present  experience, 
collecting  data  from  medical  literature,  or  by  ra- 
tional considerations.  I  shall  adopt  a  shorter  but 
not  less  conclusive  argument.  Blood-letting  for  a 
long  period  entered  largely  into  the  practice  of 
medicine.  It  commended  itself  to  practitioners  of 
sound  judgment  and  large  experience,  who  were 
good  observers.  Were  they  altogether  deceived  ? 
Is  it,  I  shall  not  say  probable,  but  possible,  that 
physicians  in  the  early  part  of  the  last  half-cen- 
tury, and  for  previous  centuries,  persisted  in  a 
measure  of  treatment  which  never  did  good,  but 
always  did  harm  ?  These  questions  involve  that 
argument.  Blood-letting  must  have  been  produc- 
tive of  more  or  less  benefit,  albeit  it  is  potential  for 
harm  as  well  as  good. 

A  fair  conclusion  is  that,  by  the  abandonment 
of  blood-letting,  a  useful  measure  of  treatment  was 
given  up.  It  was  doubtless  employed  too  indis- 
criminately and  often  carried  too  far.  Its  dangers 
and  evils  were  as  much  overlooked  as  they  are  now 
exaggerated.     Its  use  was  not  properly  regulated 


MEDICINE  OF  THE  FUTURE. 


19 


by  indications  and  contra-indications.  The  time 
will  come  (and  that  ere  long,  for  it  is  now  fore- 
shadowed) when  it  will  have  its  proper  rank  among 
therapeutic  agencies.  Physicians  will  take  advan- 
tage of  the  promptness  and  efficiency  of  its  effect 
in  certain  conditions  of  disease,  and  will  observe 
a  proper  conservatism  as  regards  its  potency  for 
harm  as  well  as  good.  To  carry  out  the  principle 
of  rejecting  remedies  because  they  are  capable,  if 
used  without  due  discrimination  and  discretion,  of 
doing  harm,  would  be  to  emasculate  the  materia 
medica.  A  remedial  agent  can  have  but  little 
value  if  it  be  not  capable  of  acting  injuriously  as 
well  as  usefully.  In  the  ability  to  employ  poten- 
tial agencies  so  judiciously  as  to  secure  their  good 
and  avoid  their  evil  effects,  lies  the  secret  of  true 
success  in  the  practice  of  medicine. 

I  come  now  to  an  event  in  the  progress  of 
medicine,  already  adverted  to  and  characterized 
as  the  crowning  epoch  in  the  medical  history  of 
the  last  half-century.  I  refer  to  bacterial  etiology. 
My  own  impressions,  in  respect  to  the  interest  and 
importance  of  this  topic,  are  such  that  my  remarks 
will  perhaps  be  considered  as  illustrative  of  that 
tendency  to  exaggeration  and  extravagance  of  utter- 
ance which  is  one  of  the  peculiarities  of  the  Ameri- 
can people.     We  are  entering  upon  a  revolution  in 


20  MEDICINE  OF   THE  FUTURE. 

medicine.  It  is  bewildering  to  project  the  thoughts 
into  the  future  in  order  to  foresee  changes  which 
will  be  brought  about,  in  the  coming  half-century, 
in  our  knowledge  of  the  causation  of  diseases  and 
the  results  as  regards  their  prevention  and  treat- 
ment. 

The  candid  reader  of  medical  history  can  not  but 
be  impressed  with  the  lack  of  accurate  information 
of  the  causes  of  disease.  In  morbid  anatomy,  ma- 
croscopical  and  microscopical,  in  symptomatology 
and  clinical  description,  in  differential  diagnosis, 
and  in  knowledge  of  the  causative  connection  with 
each  other  of  different  affections,  medicine  has  ad- 
vanced wonderfully  within  the  last  half-century. 
Can  we  say  as  much  in  behalf  of  etiology?  Put- 
ting aside  communicable  diseases,  a  reviewal  of 
medical  literature  could  leave  no  doubt  as  to  the 
answer  to  this  question.  How  many  diseases  have 
been  loosely  attributed  to  "taking  cold,"  to  physi- 
cal habits  of  life,  to  mental  conditions,  to  climate ; 
and,  when  it  has  seemed  irrational  to  specify  caus- 
ative agencies,  it  has  been  necessary  to  say  that 
they  originated  spontaneously,  overlooking  the  fact 
that  spontaneity  is  no  more  applicable  to  patho- 
logical conditions  than  to  any  other  of  the  phe- 
nomena of  nature.  It  is  a  trite  truism  to  say  that 
all  effects  have  adequate  causes.     To  say  that  a 


MEDICINE  OF   THE  FUTURE.  2 1 

disease  has  a  spontaneous  origin  is  no  less  a  sole- 
cism than  to  regard  a  waterfall  as  fortuitous,  taking 
no  account  of  gravitation.  Instead  of  saying  that 
certain  diseases  arise  spontaneously,  a  more  honest 
expression  is  a  simple  confession  of  ignorance. 

For  several  years  there  had  been  glimmerings 
of  the  light  to  be  shed  upon  the  causation  of  a  large 
and  important  class  of  diseases  which  it  is  conven- 
ient to  distinguish  as  infectious  diseases.  Indeed, 
long  before  the  recent  discoveries  in  bacterial  eti- 
ology, it  was  apparent  that  the  theory  of  the  agen- 
cy of  living  organisms  afforded  the  only  rational 
explanation  of  certain  facts  in  the  history  of  dis- 
eases now  distinguished  as  infectious.  Nearly 
fifty  years  ago,  Sir  Henry  Holland,  a  philosophical 
writer,  whose  contributions  to  literature  may  be 
read  to-day  with  pleasure  and  profit,  advocated 
"  the  hypothesis  of  animalcule-life  as  a  cause  of 
disease."  In  1847,  James  K.  Mitchell,  of  Philadel- 
phia, published  a  volume  of  much  interest,  in  which 
were  collected  a  host  of  facts  in  support  of  the 
cryptogamic  origin  of  certain  diseases.  Other 
writers,  in  different  countries,  anticipated,  on  ra- 
tional grounds,  the  demonstration  of  the  correct- 
ness of  the  so-called  germ-theory  of  the  causation 
of  diseases. 

I    assume  it  to   be   a   demonstrated  truth   that 


22  MEDICINE  OF   THE  FUTURE. 

the  specific  causes  of  certain  of  the  infectious  dis- 
eases are  micro-organisms.  I  do  not  propose  to 
inquire  how  many  of  these  diseases  have  been 
known  to  be  in  this  category  or  to  discuss  the 
evidence  in  regard  to  diseases  which  admit  of 
doubt  concerning  the  completeness  of  the  demon- 
stration. It  is  enough  for  my  present  purpose, 
that  this  truth  has  been  demonstrated  in  but  a  sin- 
gle instance.  The  point  which  I  wish  to  make  is, 
assuming  the  truth  of  the  parasitic  origin  of  any 
one  of  the  infectious  diseases,  that  it  is  a  logical  in- 
ference that  this  truth  is  applicable  to  the  other 
diseases  of  that  class.  If  relapsing  fever  be  shown 
to  depend  on  a  contaghmi  vivum,  small-pox  and  the 
other  eruptive  fevers  have  a  similar  dependence. 
If  typhoid  fever  proceed  from  a  specific  micro- 
organism, so  does  typhus  fever.  If  yellow  fever  be 
parasitic,  so  is  intermittent  fever.  Moreover,  the 
discovery  of  a  specific  micro-organism  as  the  cause 
of  a  disease,  places  it  in  the  class  of  infectious  dis- 
eases, although  it  had  not  previously  been  consid- 
dered  as  belonging  in  this  class.  Microscopical  re- 
searches have  thus  lately  enlarged  this  class  of  dis- 
eases, and  the  enlargement  is  likely  to  continue. 
Phthisis  pulmonalis  was  regarded  by  few,  if  any, 
as  an  infectious  disease  prior  to  the  discovery  of 
the  bacillus  tuberculosis.     If  my  reasoning  be  cor- 


MEDICINE  OF   THE  FUTURE.  23 

rect,  it  is  simply  a  question  of  time  as  to  the  dis- 
covery of  specific  organisms  for  all  the  infectious 
diseases. 

It  is,  to  say  the  least,  an  innocent  indulgence  of 
the  imagination  to  consider  the  influence  of  these 
discoveries  upon  medicine  in  the  future.  Having 
acquired  knowledge  of  the  natural  history  of  the 
different  species  of  parasitic  organisms,  a  great 
practical  object,  of  course,  is  to  find  means  for  their 
destruction  within  the  body.  Despite  difficulties, 
this  object  will  be  accomplished.  The  parasiticides 
in  cases  of  malarial  fever  were  long  ago  discovered, 
although  it  is  not  certain  that  the  parasite  has  yet 
been  described.  Here  is  a  disease  completely  un- 
der control  by  remedies,  the  efficacy  of  which  is 
to  be  explained  by  their  destructive  effect  on  a  spe- 
cific organism.  Imagine  all  the  infectious  diseases 
to  be  as  fully  under  control  as  are  now  the  malarial 
affections  !  Is  it  an  exaggeration  to  say  that  a  revo- 
lution in  medicine  would  then  have  taken  place  ? 
This  revolution  will  hereafter  be  dated  from  the  re- 
cent discoveries  in  bacterial  etiology. 

It  may  be  said  that  these  discoveries  do  not 
warrant  the  glowing  thoughts  of  the  future  which 
I  have  ventured  to  express,  and  that,  up  to  the  pres- 
ent time,  they  are  barren  as  regards  practical  re- 
sults.     Granted  difficulties  never  so   great,  when 


24 


MEDICINE  OF   THE  FUTURE. 


some  of  these  are  overcome,  the  way  will  be 
opened  to  overcome  others  more  easily.  To  find 
an  efficient  and  safe  destructive  agent  for  each  spe- 
cies of  pathogenic  organisms,  together  with  an 
effectual  method  in  its  employment,  is  not  the  only 
object  to  be  kept  in  view  in  order  to  control  infec- 
tious diseases.  The  presence  of  parasites  is  but  one 
factor  in  the  etiology  of  these  diseases.  Conditions 
favorable  for  the  lodgment,  growth,  multiplication, 
and  colonization  of  parasitic  organisms — conditions 
which  constitute  a  peculiar  predisposition  or  di- 
athesis— are  not  less  essential.  If  these  can  be  re- 
moved, the  control  will  be  as  complete  as  if  effected 
by  parasiticides.  Ground  is  as  yet  hardly  broken 
in  this  field,  and  it  is  useless  to  speculate  concern- 
ing the  future  products  of  its  cultivation.  It  is  not 
improbable  that  labors  in  this  direction  may  be 
more  speedily  successful  than  efforts  to  discover 
toxical  agents  which  destroy  pathogenic  organisms, 
leaving  the  patient  unharmed. 

To  say  that  knowledge  of  bacterial  etiology 
will  lead  to  effective  means  for  the  arrest  of  in- 
fectious diseases  is  not  perhaps  to  indicate  the  most 
important  way  in  which  this  knowledge  is  to  influ- 
ence medicine  in  the  future.  The  destruction  of 
organisms  outside  of  the  body  by  disinfectants, 
and  by  the  removal  of  all  the  accessory  conditions 


MEDICINE  OF   THE  FUTURE.  25 

necessary  to  their  existence,  together  with  their 
effectual  exclusion  from  the  body,  may,  and  in- 
deed it  is  more  than  probable  will,  reduce  the 
fatality  from  infectious  diseases,  in  the  order  of 
Providence,  much  sooner  than  the  discovery  of 
effective  therapeutic  agents.  Moreover,  there  are 
present  intimations  of  important  discoveries  re- 
specting inoculation  with  attenuated  viruses  and 
contagia  in  order  to  forestall  the  development  of 
infectious  diseases.  Here  open  up  to  the  imagina- 
tion the  future  triumphs  of  preventive  medicine  in 
respect  to  all  classes  of  disease.  The  zeal  and 
activity  in  this  department  of  medicine  often,  in 
spite  of  obstacles  arising  from  popular  prejudice 
and  indifference,  redound  to  the  glory  of  the 
medical  profession. 

Putting  aside  bacteriology,  are  there  not  patho- 
logical conditions,  of  which  little  or  nothing  is  now 
known,  which  await  important  developments  of 
knowledge  in  the  future?  The  spleen  must  have 
functions  liable  to  perversions,  at  present  but  little 
understood.  Much  remains  to  be  learned  respect- 
ing the  hepatic  functions,  and  we  may  look  for- 
ward to  the  time  when  the  term,  biliousness, 
handed  down  from  Hippocrates  and  Galen,  shall 
have  some  definite  meaning,  and  when  the  liver 
will  no  longer  be  available  as  a  convenient  source 
4 


26  MEDICINE  OF   THE  FUTURE. 

of  ailments,  the  origin  of  which  is  confessedly  un- 
known. Can  it  be  doubted  that  the  pathological 
conditions  of  the  chylopoetic  and  the  haemato- 
poetic  systems  will  in  due  season  be  elucidated, 
when  will  be  found  the  missing  link  which  binds 
together  leucocythaemia,  Hodgkins's  disease,  Addi- 
son's disease,  and  pernicious  anaemia,  and  when 
new  toxical  agents  in  the  blood  will  be  brought 
to  light?  The  glands  of  the  stomach,  it  is  esti- 
mated by  Leube,  secrete  thirty  pounds  of  gastric 
juice  per  diem,  and  the  glands  of  Lieberkiihn,  an 
unknown  but  undoubtedly  a  very  large  quantity 
of  intestinal  juice ;  yet,  •  lesions  affecting  these 
extensive  glandular  systems,  and  their  functional 
disorders,  are  hardly  recognized  in  the  nosolo- 
gy. Here  is  a  vast  and  fruitful  field  for  future 
clinical  researches.  The  thyroid  body,  the  lym- 
phatic glands,  and  the  supra-renal  capsules  must 
have  important  physiological  functions  not  yet  as- 
certained, and  a  corresponding  importance  in  pa- 
thology. When  I  think  of  the  future  discovery  of 
pathological  conditions,  I  connect  my  thoughts 
with  the  reflection,  how  great  has  been  the  influ- 
ence of  the  researches  of  Bright  on  the  doctrines 
and  practice  of  medicine  ;  and  yet,  within  my  own 
recollection,  the  relations  of  the  kidneys  to  dropsy 
and  uraemia  were  unknown. 


MEDICINE  OF   THE  FUTURE.  27 

I  should  not  do  justice  to  my  subject  without 
offering-  some  thoughts  concerning  medical  litera- 
ture; medical  instruction,  and  the  medical  profes- 
sion of  the  future. 

With  each  successive  decade  in  the  last  half- 
century,  the  medical  press  has  been  more  and  more 
prolific.  The  fecundity  is  likely  to  increase  rather 
than  diminish.  There  is  no  prospect  of  a  meno- 
pause. What  a  progeny  may  be  expected,  at  the 
end  of  the  next  half-century  !  Consider  the  situa- 
tion, at  the  present  time,  of  that  unfortunate  per- 
son so  often  mentioned  as  the  "  busy  practitioner"  ! 
He  is  naturally,  as  is  to  be  hoped,  anxious  to  be 
au  cotirant  with  French,  German,  and  English  medi- 
cal literature.  With  each  successive  month  he 
consults  the  Index  Medicus,  "  a  monthly  classified 
record  of  the  current  medical  literature  of  the 
world."  If  he  be  thoroughly  discouraged  at  this 
day,  what  must  be  the  state  of  mind  produced  by 
consulting  an  Index  Medicns  in  the  year  1936?  The 
truth  is,  that,  at  the  present  time,  and  still  more  in 
the  future,  the  range  of  reading  and  study  must  be 
restricted,  in  a  great  measure,  to  limited  parts  of 
the  vast  field  of  medical  literature. 

The  multiplicity  of  medical  publications  repre- 
senting real  advancement  of  knowledge  in  the  sev- 
eral  branches   of   medicine   must   lead   to   certain 


28  MEDICINE  OF   THE  FUTURE. 

changes,  some  of  which  may  be  called  reforms. 
Clinical  studies  will,  of  course,  always  hold  a 
foremost  place  among-  the  means  of  advancing 
knowledge  of  medicine ;  but  there  must  be  less 
superfluity  of  reported  cases  and  less  redundancy 
of  details  in  published  histories.  A  reform  in  these 
regards,  as  may  be  hoped,  will  extend  to  the  tedi- 
ous oral  recitals  of  interesting  cases,  rendering  tire- 
some the  meetings  of  medical  societies  and  some- 
times marring  the  pleasure  of  social  intercourse. 
The  time  may  come  when  fewer  books*  will  be 
written  with  a  view  to  impress  upon  credulous 
readers  the  superior  attainments  and  skill  of  their 
authors  as  practitioners  in  some  special  province 
of  practice.  It  may  be  hoped,  also,  that  future  pub- 
lications will  abound  much  less  in  the  profitless 
minutiae  of  observations,  experiments,  and  in  tabu- 
lated data,  representing  often  labor  without  valu- 
able results.  Another  reform  is  the  elimination 
of  complicated  schematic  devices  and  ingeniously 
colored  diagrams,  laden  with  figures  and  embel- 
lished with  curved  lines.  Future  authors  will 
be  forced  not  to  encumber  books  with  a  digest 
of  all  the  past  literature  of  the  subjects  treated 
of.  The  necessity  for  condensation  and  concise- 
ness will  become  imperative.  It  is  now  true — 
but  future  readers  will  appreciate  more  fully  the 


MEDICINE  OF   THE  FUTURE. 


29 


truth — that  art  is  too  long  and  life  too  short  for 
busy  practitioners  to  wade  through  bulky  volumes 
or  Extended  articles  in  order  to  ascertain  whether 
or  not  they  contain  aught  of  value.  It  will  be 
requisite  that  books  shall  contain  a  fair  synopsis  of 
their  contents,  so  that  judgment  can  be  formed  be- 
forehand whether  time  will  be  wasted  in  a  careful 
reading  from  cover  to  cover.  Compendiums,  ana- 
lytical reviews,  and  the  catalogue  raisonne"  of  libra- 
ries, of  great  use  at  all  times,  will  be  indispensable 
in  the  future.  These  and  other  contrivances  must 
be  resorted  to  for  repressing  and  counteracting 
the  exuberance  of  medical  bibliography. 

Voluminous  encyclopedic  works  have  probably 
had  their  day.  It  is  doubtful  if  a  French  publisher 
will  hereafter  be  bold  enough  to  repeat  an  enter- 
prise like  that  of  the  Nouvcau  Dictionnaire  de  Mdde- 
cine  ct  de  Chirurgie  pratiques,  which  was  begun  in 
1864  and,  after  the  publication  of  thirty-eight  oc- 
tavo volumes,  has  but  lately  reached  the  end  of  the 
alphabet.  The  German  work  edited  by  Ziemssen, 
and  entitled  a  Handbuch — a  name  which  one  might 
suspect  to  be  a  pleasantry,  if  the  character  of  Ger- 
man writers  laid  them  open  to  such  a  suspicion — a 
translation  of  which,  more  pretentiously  called  an 
"  Encyclopaedia  of  Practical  Medicine,"  was  pub- 
lished in  America,  in  seventeen  volumes,  and  is  un- 


30  MEDICINE  OF   THE  FUTURE. 

doubtedly  a  work  of  value.  But,  although  several 
years  have  elapsed  since  the  last  volume  was  issued, 
the  publishers  probably  have  reason  to  congratu. 
late  themselves  that  the  work  was  sold  by  sub- 
scription. 

There  is  reason  for  thinking  that  text-books 
which  assume  to  extend  over  the  whole  domain  of 
medicine  will  soon  belong  to  the  past.  Owing 
to  the  progress  in  knowledge  of  diseases,  and  the 
developments  in  etiology,  pathology,  and  thera- 
peutics which  this  progress  involves,  it  will  soon 
require  not  a  little  hardihood  for  an  author  to  un- 
dertake to  furnish  even  a  minimum  of  information 
that  the  medical  student  and  the  practitioner  are 
expected  to  acquire  of  all  or  a  considerable  part  of 
the  diseases  embraced  in  the  nosology.  Hereafter 
the  department  of  medical  literature  embracing  the 
principles  and  practice  of  medicine  will  consist  of 
works  limited  to  individual  diseases  or  to  nosologi- 
cal divisions.  The  accumulation  within  late  years 
of  the  increasing  number  of  treatises  on  diseases  of 
the  lungs,  heart,  nervous  system,  throat  and  nose, 
liver,  stomach,  bowels,  kidneys  and  bladder,  the 
diseases  of  children,  the  diseases  peculiar  to  women, 
eruptive  diseases,  fevers,  gout,  etc.,  render  it  evi- 
dent that  such  works  must  supersede  those  intended 
to  cover  the  whole  range  of  medical  practice. 


MEDICINE  OF   THE  FUTURE.  31 

Passing  from  medical  literature  to  medical  in- 
struction, correlative  changes  in  the  latter  are  to 
be  expected.  Fifty  years  ago,  it  was  customary 
for  a  professor  of  medicine  to  write  out  in  full  lect- 
ures on  pathology  and  practice  (sometimes  in- 
cluding physiology)  which,  with  interlineations, 
were  re-read  year  after  year.  To  this  custom  the 
medical  professor  is  indebted  for  the  inimitable  work 
of  Watson.  The  custom  now  belongs  to  the  past. 
The  progress  of  medicine  has  made  its  continuance 
impracticable.  More  teaching  and  more  teachers 
are  indispensable.  The  amount  of  teaching  and 
the  number  of  teachers  must  continue  to  increase. 
The  whole  of  general  pathology  can  not  longer 
be  incorporated  with  practical  medicine.  Special 
branches  require  special  teachers,  and  the  number 
of  special  branches  will  multiply. 

1  predict  that  didactic,  except  as  complemental 
to  clinical  teaching,  will  be  more  and  more  re- 
stricted, and  perhaps  at  length  be  discontinued, 
recitations  and  the  study  of  books  taking  its  place. 
Observation  of  the  phenomena  of  disease,  together 
with  practical  exercises  in  diagnosis  and  the  appli- 
cations of  therapeutics  to  individual  cases,  are  to  the 
study  of  medicine  what  experimental  illustrations 
are  to  the  study  of  chemistry  and  physics ;  or,  not 
going  without  the  domain  of  medicine,  they  are 


32 


MEDICINE  OF   THE  FUTURE. 


what  the  use  of  the  scalpel  is  in  the  study  of  anat- 
omy, and  the  use  of  the  microscope,  in  the  study  of 
histology.  To  point  out  and  explain  the  pathologi- 
cal character  and  diagnostic  import  of  morbid  phe- 
nomena, as  manifested  in  cases  of  disease  under 
observation,  to  secure  practical  familiarity  with 
methods  of  examination,  and  to  demonstrate  the  re- 
sults of  practice — these  are  now,  and  will  be  still 
more  in  the  future,  the  chief  ends  of  oral  instruc- 
tion in  medicine. 

Bedside  teaching  and  practical  work  in  the  histo- 
logical laboratory  will  henceforth  form  an  essential 
part  of  medical  instruction.  The  medical  student 
must  not  only  learn  what  is  already  known  of  the 
practical  applications  of  microscopy,  but  he  may  be 
incited  thereby  and  qualified  to  extend  the  bounda- 
ries of  knowledge  in  physiology  and  pathology. 
The  study  of  the  functions  of  the  organs  and  tissues 
of  the  body  in  health  and  disease,  of  etiology,  and  of 
therapeutics,  must  include  experiments  on  lower 
animals.  It  is  a  painful  reflection  that  this  study  is 
hampered  by  penal  restrictions  in  the  most  enlight- 
ened country  on  the  globe.  Yet  this  is  not  a  soli- 
tary instance,  within  the  last  half-century,  of  ob- 
struction to  the  progress  of  medicine  by  popular 
prejudice  based  on  ignorance.  It  is  not  very  long 
since  the  study  of  practical  anatomy  involved  the 


MEDICINE  OF   THE  FUTURE. 


33 


necessity  of  either  committing  or  being  accessory  to 
what  the  law  of  the  land  declared  to  be  felony.  The 
dissection  of  the  human  body,  in  the  eyes  of  legisla- 
tors, denoted  a  ghoul-like  propensity  developed  by 
the  study  of  medicine.  The  dissemination  of  popu- 
lar knowledge  has  effaced  this  stigma  in  most  civi- 
lized countries.  So  will  it  be  in  the  future  with  what 
we  may  call  experimental  medicine.  The  profession 
in  America  look  to  the  mother-country,  as  well  as 
to  France  and  Germany,  for  the  active  employment 
of  all  proper  means  for  the  advancement  of  medical 
knowledge.  English  jurisprudence,  near  the  end  of 
the  nineteenth  century,  in  an  attitude  of  hostility 
to  investigations  inspired  by  humanity  and  having 
no  motive  or  object  save  the  welfare  of  mankind, 
is  indeed  a  strange  spectacle.  As  evidence  of  a 
prevailing  popular  sentiment  of  justice  toward  the 
medical  profession,  it  is  to  be  hoped  that  British 
novelists  will  ere  long  find  more  worthy  objects  for 
the  exercise  of  the  imagination  than  the  portrayal 
of  a  vivisector  as  a  person  to  be  shunned  or  de- 
spised. 

The  medical  profession  of  the  future — this  topic 
offers  scope  enough  for  thought,  but  my  temerity 
is  not  sufficient  for  me  to  trespass  except  for  a  few 
moments  on  your  further  indulgence. 

The  ideal  physician  of  the  future,  representing 


34  MEDICINE  OF   THE  FUTURE. 

an  advanced  stage  in  the  progress  of  medicine,  will 
be,  it  is  to  be  presumed,  a  better  practitioner  than 
the  physician  of  our  time.  His  practice  will  exem- 
plify more  knowledge  of  pathology  and  etiology, 
together  with  advancement  in  therapeutics  and 
prophylaxis.  We  can  fancy  that,  on  appropriate 
occasions,  at  the  end  of  the  next  half-century,  he 
will  review  past  medical  history,  and  with  com- 
placency, as  viewed  from  his  standpoint,  amplify 
on  the  defects  and  errors  of  the  practitioners  who 
represent  the  present  stage  of  medical  progress. 

The  progress  of  medicine  induces,  slowly  but 
surely,  changes  in  popular  ideas.  The  physician 
of  the  future  will,  perhaps,  not  be  better  appreciated, 
but  there  will  be  a  truer  estimate  of  medical  knowl- 
edge and  of  the  medical  profession.  It  is  a  pleas- 
ant thought  that  hereafter  the  practice  of  medicine 
may  not  be  so  closely  interwoven  as  hitherto,  in 
the  popular  mind,  with  the  use  of  drugs.  The  time 
may  come  when  the  visits  of  the  physician  will  not 
as  a  matter  of  course  involve  the  co-operation  of  the 
pharmacist ;  when  medical  prescriptions  will  be  di- 
vested of  all  mystery  and  have  no  force  in  the  way 
of  fortifying  the  confidence  of  the  patient.  The 
medical  profession  will  have  reached  a  high  ideal 
position  when  the  physician,  guided  by  his  knowl- 
edge of  diagnosis,  the  natural  history  of  diseases, 


MEDICINE  OF   THE  FUTURE. 


35 


and  existing  therapeutic  resources,  may,  with  nei- 
ther self-distrust  nor  the  distrust  of  others,  treat 
an '  acute  disease  by  hygienic  measures  without 
potent  medication.  When  this  time  comes,  a  sys- 
tem of  practice  which  assumes  to  substitute  me- 
dicinal dynamics  for  the  vis  medicatrix  natures  will 
have  been  added  to  the  list  of  by-gone  medical  de- 
lusions. 

But  we  must  not  look  into  the  future  exclusively 
in  the  light  of  optimism.  Are  there  no  prospective 
dangers  incident  to  the  progress  of  medicine?  Let 
me  briefly  advert  to  one  source  of  apprehension. 

The  unavoidable  subdivision  of  medical  litera- 
ture and  medical  instruction  into  special  depart- 
ments makes  necessary,  to  a  certain  extent,  special- 
ism in  the  practice  of  medicine.  It  is  certain  that 
this  will  not  lessen,  but  increase,  in  the  near  fu- 
ture ;  and  it  is  important  to  think  of  possible  emer- 
gencies which  are  even  now  foreshadowed.  Spe- 
cialism conduces  to  the  advancement  of  knowl- 
edge. It  behooves  us,  however,  to  consider,  were 
the  practice  of  medicine  to  be  given  up  to  spe- 
cialists, what  would  become  of  the  medical  pro- 
fession. With  due  appreciation  of  services  devoted 
to  special  branches  of  medical  knowledge,  there 
are  tendencies  pertaining  to  the  practice  of  a  spe- 
cialty that  should  not  be  overlooked.     I  shall  only 


36  MEDICINE  OF   THE  FUTURE. 

allude  to  the  danger  of  what  may  be  called  profes- 
sional demoralization.  I  do  not  care  to  speak  of 
those  who  adopt  a  specialty  for  other  than  the  mo- 
tives which  have  governed  worthy  physicians  in 
all  ages.  A  dangerous  tendency  is  to  such  a  limi- 
tation to  a  specialty  as  will  lead  to  withdrawal  from 
the  common  interests  of  the  profession.  A  medi- 
cal specialist  should  not  thereby,  in  his  sentiments 
and  conduct,  be  any  the  less  a  physician ;  the  hon- 
or, dignity,  and  usefulness  of  the  profession,  as  a 
whole,  should  be  as  sacred  in  his  estimation  as  if 
he  were  not  a  specialist.  If  the  effect  of  specialism 
be  otherwise,  alas  for  the  medical  profession  of  the 
future,  as  regards  the  respect  of  others  and  the  self- 
respect  of  its  members !  For  one,  I  can  not  believe 
that,  in  the  order  of  Providence,  the  destiny  of  this 
profession  is  its  degradation.  The  history  of  medi- 
cine has  made  the  medical  profession  most  honor- 
able, and  I  believe  that  it  has  a  glorious  future. 

Mr.  President,  I  can  not  adequately  express  my 
appreciation  of  the  honor  of  an  invitation  to  read 
an  address  on  medicine  at  a  meeting  of  the  British 
Medical  Association.  I  am  well  aware  that  the  in- 
vitation was  intended,  not  as  a  personal  compliment 
so  much  as  a  manifestation  of  good-will  toward  the 
medical  profession  of  the  United  States,  where  the 


MEDICINE  OF   THE  FUTURE.  37 

same  language  is  spoken,  a  common  literature  en- 
joyed, and  where  the  institutions,  literary,  educa- 
tional, scientific,  philanthropic,  and  political,  are 
modeled  largely  after  those  of  the  parent  country. 
On  behalf  of  my  American  brethren  I  tender  to 
yourself  and  to  the  members  of  the  British  Medical 
Association  sincere  thanks.  The  gratification  with 
which  the  invitation  was  accepted  would  have  been 
without  any  drawback  could  I  have  felt  confident 
of  my  ability  to  do  justice  to  the  opportunity  and 
the  occasion. 


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